Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Cardiovascular Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Catheter Cardiovasc Interv. 2020 Feb 15;95(3):471-476. doi: 10.1002/ccd.28598. Epub 2019 Nov 19.
This article aims to describe the feasibility of a novel application of the Diabolo stent technique for percutaneous downsizing of systemic-to-pulmonary artery shunts in patients with pulmonary overcirculation.
Pulmonary overcirculation can lead to systemic hypoperfusion, impaired systemic oxygen delivery, and hemodynamic instability especially in patients with single-ventricle physiology. Different medical and surgical strategies to treat pulmonary overcirculation have been reported so far, but no percutaneous approach amenable to further adjustment over time has been described.
Retrospective review of patients who underwent percutaneous intraluminal reduction of a systemic-to-pulmonary artery shunt with a covered stent in a Diabolo "hour-glass" configuration.
From July 2018 to February 4, 2019, consecutive patients underwent trans-catheter downsizing of a systemic-to-pulmonary artery shunt. The median age was 3.3 years (range 0.7-5.7 years). All patients had symptomatic pulmonary overflow despite maximal medical therapy. All patients underwent successful implantation of a covered stent in a Diabolo "hour-glass" configuration without any complications. Successful reduction in pulmonary overcirculation was noted in all patients with a decrease of mean pulmonary artery pressure from a median of 29 mmHg (range 25-32 mmHg) to a median of 21 mmHg (range 14-27 mmHg).
Percutaneous intraluminal downsizing of systemic-to-pulmonary artery shunts with a covered stent in a Diabolo configuration is safe and feasible. With this technique, the pulmonary blood flow can be adjusted in a physiologic closed-chest condition and further regulated over time.
本文旨在描述一种新型 Diabolo 支架技术在治疗肺循环过度患者体肺动脉分流的经皮缩小术的可行性。
肺循环过度可导致全身低灌注、全身氧输送受损和血流动力学不稳定，特别是在单心室生理患者中。迄今为止，已经报道了不同的治疗肺循环过度的医疗和手术策略，但尚未描述一种可随时间进行进一步调整的经皮方法。
回顾性分析了 2018 年 7 月至 2019 年 2 月 4 日期间接受经导管治疗体肺动脉分流的患者，采用 Diabolo“沙漏”构型的覆盖支架进行腔内缩小术。
连续的患者接受了经导管治疗体肺动脉分流的缩小术。中位年龄为 3.3 岁（范围 0.7-5.7 岁）。所有患者均有症状性肺溢出，尽管接受了最大的药物治疗。所有患者均成功植入 Diabolo“沙漏”构型的覆盖支架，无任何并发症。所有患者的肺循环过度均成功缩小，平均肺动脉压从中位数 29mmHg（范围 25-32mmHg）降至中位数 21mmHg（范围 14-27mmHg）。
经导管腔内缩小术治疗体肺动脉分流的方法是安全可行的。通过这种技术，可以在生理闭合胸腔条件下调整肺血流量，并随时间进一步调节。
